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APPLICATION FOR SANITATION PERMIT Permit No. .- (-. (Complete in Duplicate) Date Issued ` in described. Application is hereby ade to the San Joaquin Local Health District f49 a permit to construct and install the work here , This aplication is made in compliance with County Ordinance -•-----------•-------- ------------------------------------------ JOB ADDRESS AND LOCATION_______ __ _ ___ Phone ------------------------------- Owner's ------ --------------------- T- -- -t---------- __ ---- --------- - Owner's Name2 1 _r - qq ------------------ a Address-------- --------- - one Contractor's Name__________ __ __ p / �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Caur} ❑ Motel Other ❑ _-. Lot size ` . Number of living units: __C____ Number of bedrooms -- Number of baths.)___ - --- ! Priv ❑• DepfK'to Water Table ft. l Water Supply: Public system Ey Community system .❑ la Loam Clay ❑ Adobe Hardpan ❑ ravel Sandy Loam ❑ Y ❑ Character of soil to a depth of 3 feet:' Sand ❑ ❑ Application Made: Yes ❑ No New Construction: Yes o ❑ l Previous App . 1 TYPE:OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material----------------------------------------------- nearest --- ------- ------- -------•-------- ------- I Septic Tank: Distance from nearest well_--_----_--.----Distance from foundation------------------_. Sze Liquid dept----------------------- - Capacity_. t No. of compartments------------ ---------- Distance to nearest lot line__I- -------- -//. ---• I Distance from foundation- . a DispBsal'Fiel Distance from Weare t well/ Width of trench-..' ,- ----- ----- Number of lines----- .�1, __Length of each line__.--+.,�� ------j---- 00 - De th of filter mater.iai•_,_._�_�-`�---Total length_______ -- --�--------- -------- I Type of filter material__!- ----- P 1-47-_---- '' -- � Distance from fo dation_-�4----------Distpce to nearest lot line_. Seepage Pit: Distance to OE wellllFd_ ------De th------ �-- ----------- ,, p _.Size::Diameter.___ ----. P Number of pits_--_0 - �+""� -Lining material-_ Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material.___-_.________.__--__.._--- ---- _. Size: Diameter-------------------_-:--.-:--------.Qepth,---- --------- -------------- ------ ---------,-Liquid Capacity------------------------- Size: ----------y�T----- f � •� f r. y .�.._ ❑ _. ,,,�.: ..r,�•�-•--��--- - •-�'_"'-- - -- - -------- Distance from nearest building--------------------------------- Distance ----- ----------------------- ----�. - Distance from nearest well--------------------------------------- ---- a ❑ Distance to nearest lot line-------- ------ -_-. - ------ - -- -- --- e '« - '-- ----- ---- --' - -�- Remodeling and/or repairing (describe):--------------- - ------ - ------------ _- -- -------- -_. --- _ -- ---- - --- �- - - -----------------=--- --•---- - C 7 ----- -- .•----------------------- ---.---_----------- - -- - - -- - ------ ----------- ----- - 1 hereby certify that I havespaedared-thi ons Ili the San Joaquin the hLo alk will heDione n accordance wi+ San Joaquin County i ordinances, State laws and ------- wn er gd/or Con ac+or (Signed P �-------- -- +... ----{Tit) -------- - �-- ---- -� �� j�r - --------------- By:.:.--�• f (Plot plan, showing size of lot, location of sys}em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �^ DATE------------------ - --1-- -J -- ----- --------------- APPLICATION ACCEPTED B ----- DATE--------------------- REVIEWED BY BUILDING PERMIT ISSUED--------:------------------ ----------------------------------------- ----------------------- Alterations and/or recommendations--------------------------- - --------------------..___.----.----- -------------------------------------------- ----;.. . 57Z C f 4 ,/- ._ /___________________________------------------•- / �� Date-- -- FINAL INSPECTION BY•--------------- f j SAN JOAQUIN LOCAL HEALTH DISTRICT 132 sycamore Street 814 North "C" Street Lodi, California30 South American Street 30D West Oak ntree+ Manteca, California Tracy, California i 4 Stockton, California ES--9-2M 10-52 Revised W-2100 t. _